Provider Demographics
NPI:1326589516
Name:PIPER, BRENT (MA MHC)
Entity Type:Individual
Prefix:
First Name:BRENT
Middle Name:
Last Name:PIPER
Suffix:
Gender:M
Credentials:MA MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 MARTENSE ST
Mailing Address - Street 2:APT 3F
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-3370
Mailing Address - Country:US
Mailing Address - Phone:651-208-4522
Mailing Address - Fax:
Practice Address - Street 1:1133 BROADWAY
Practice Address - Street 2:SUITE 608
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-7903
Practice Address - Country:US
Practice Address - Phone:651-208-4522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-20
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP04291101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health